COVID-19.

Top Line: While we are by no means public health or infectious disease experts, there’s been an unfortunate lack of information on the national level to guide radiation oncologists (heck, American citizens) on how to act when COVID-19 hits their community.
Thoughts: Here are some thoughts on how to specifically adapt the very non-specific COVID-19 recs to rad onc practices. It can be framed in three phases. First, there may be some practices in communities that haven’t had any cases. For them, the focus is vigilant screening and hygiene. In a second phase, COVID-19 is in your community, but hasn’t affected a patient or staff member at your center. What to do? Here are the facts: median incubation time is 4 days (2-7 IQR), the main symptoms are fever and cough, most cases have radiographic evidence of pneumonia if you look for it, and transmission is usually from symptomatic patients but can come from asymptomatic patients or in people who haven’t yet developed symptoms (which, yes, means you could easily be in phase 3 without knowing it). Viral load is also exceedingly high early in convalescence. These latter points are very important for a rad onc clinic where we have a mix of relatively young, healthy people as well as vulnerable patients at high risk of developing severe disease. From a staffing standpoint, many are moving to split staffing and remote work whenever feasible (that means for most treatment planning). The goal here is to avoid a situation with widespread exposure where the entire therapy or nursing staff has to self-quarantine. In the case of dramatic understaffing, many centers are creating a triage structure for worst case scenarios where potentially curative patients remain on-treatment followed by urgent palliative cases and then non-urgent palliation. Last, what to do when you have an infected patient? Some are considering a similar split-schedule where infected or exposed patients who require treatment all come in during a specific block of treatment time (typically the end of the day) with minimal staff to reduce exposure. This could help staff take extra precautions during that time, lower the risk of spread to unaffected patients, and allow for a time of intensive decontamination of treatment rooms.
TBL: Whether you are in a big or small practice, sit down today with your leadership to devise an emergency preparedness plan to maximize your patients’ chances of safely completing their radiation treatments. | QuadShot Team 2020

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